Saline‐Filled Breast Implant Contamination with Curvularia Species among Women Who Underwent Cosmetic Breast Augmentation
1Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, and Divisions of 2Healthcare Quality Promotion, 3Bacterial and Mycotic Diseases, and 4Public Health Surveillance and Informatics, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; 5Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Background.
During December 2000–July 2001, black sediment was noted in saline‐filled silicone breast implants of women who had undergone revision surgery at facility A. Curvularia fungus was isolated from implant saline.
Methods.To identify risk factors for contamination with Curvularia species, we performed case‐control, retrospective cohort, and laboratory studies and conducted procedural reviews. A case patient was defined as any woman who underwent revision surgery at facility A between January 2000 and June 2001 and had black sediment in her implants.
Results.Five patients met the case definition. Contamination was associated with having had surgery performed in operating room (OR) 2 (4/88 vs. 1/140; 
) and a longer duration of surgery (
). A longer duration spent in the OR was an additional risk factor (
). Curvularia fungus was isolated from the sterile supply room, where saline bottles had been stored under a water‐damaged ceiling, and from the corridor outside OR 2; it was also found more commonly from facility A personnel than from non–facility A personnel (12/34 vs. 4/60; 
). Saline was warmed in a cabinet opposite OR 2, which was maintained at negative pressure differentials, then was poured into bowls open to the OR 2 environment before injection into implants.
Conclusion.Surgeons should always use closed systems to inflate breast implants. Surgery center infection control measures must include moisture control and balanced ventilation systems.
Received 20 September 2004; accepted 28 January 2005; electronically published 18 May 2005.
Cited by
Online publication date: 1-Apr-2008.
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Presented in part: 40th Annual Meeting of the Infectious Diseases Society of America, Chicago, 24–27 October 2002 (abstract 416).
Financial support: The investigation upon which this study is based was conducted while the authors were employees of the Centers for Disease Control and Prevention. The US Public Health Service underwrote all funding for this investigation.
Since submitting this manuscript, M.A.K. has provided professional clarification and interpretation on the results of this investigation to attorneys involved in pending court cases regarding this incident.
The use of trade names is for identification only and does not imply endorsement by the US Public Health Service or the US Department of Health and Human Services.
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Present affiliations: Tennessee Department of Health, Nashville, Tennessee (M.A.K.); Regeneration Technologies, Inc., Alachua, Florida (L.K.A.).
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W.R.J. is now retired and in private practice.